SALEM INTERNATIONAL UNIVERSITY
Online Housing Application

This application does NOT admit you to the University. Application for admissions to Salem International University must be made separately and can be found HERE. Advanced registration and housing deposit must be paid prior to submitting this form.
STUDENT INFORMATION
Last Name:
First Name:
Middle Name:
Social Security:
Sex:
Date of Birth: / /
Are you a transfer student?
If yes, name of college/university:

Class Standing:

Applying for:
Module #:
 
Email:  
PERMANENT ADDRESS INFORMATION
Street / P.O. Box:
City:
State:
Zip Code / Postal Code:
Country:
Phone:
EMERGENCY INFORMATION - In case of emergency contact:
Contact Person's Full Name:
Street / P.O. Box:
City:
State:
Zip Code / Postal Code:
Country:
Phone:
OTHER INFORMATION

Please answer the following questions in order to help us make the best roommates matches possible. We will attempt to meet special requests but can not guarantee them.
Specific person you would like as a roommate:
What time do you prefer to study?
Where do you prefer to study?
If other, where:
Are you a smoker?
Would you share a room with a smoker?

What is your major?


SIU Athletic Team, if any?
I typically go to bed at:
My favourite type of music is:
My hobbies are:

I uderstand that acceptance of this application does not guarantee assignment to a residence hall or admission to the University. I have also read and understand the terms of this application as stated under Residence Halls Policies.
Check the box if you agree with the above statement:
If you have completely filled out this form click the submit form button.